Dysmenorrhea ( algomenorrhea ) - Causes, Symptoms and Treatment .MF .
Dysmenorrhea (or algosdismenoreya) - a pathological condition in which the main symptom is a sharp pain during menstruation, especially in the abdomen and in the lumbar region.This condition must be diagnosed by normal menstrual pain, which can be the same in different cycles.
Women conversion rate to the doctor complaining of painful periods is according to various estimates from 10 to 35% of cases among all reasons for resorting to the gynecologist.Most often such complaints to the doctor come to young women of childbearing age.Due to the fact that this pathology often causes unbearable pain, today it is considered as an important social problem: a woman loses the ability to work, there are problems in his personal life.
To date, no clear idea of why young women have dysmenorrhea.Worthy of attention is one of the versions, which states that pathological pain is associated with an increased content (products) of prostaglandins (PGs), especially PG F2α.
Prostaglandins - bio
Therefore, if PG F2α concentration in the blood greatly increased that occurs in some women during menstruation, the force of contraction of the myometrium in such patients is significantly greater than normal, causing sharp pain.Furthermore, such an abnormal reduction may lead to ischemia (circulatory disorders) myometrium individual sections that can bring to the death of the tissue.
should not also forget about the different susceptibility to pain - patients with a high threshold of pain sensitivity less likely to seek medical attention than low.This may be due to the enhanced performance of opiates (endorphins), which in varying degrees in different ways to block the pain and help her carry in different ways.
also believed that dysmenorrhea may be due to a malfunction in a chain of the hypothalamic-pituitary-ovarian regulation of the menstrual cycle.This may also help to increase the blood and increased prostaglandin production in their tissues.
main symptom algodismenorei are certainly painful periods, mainly in the first days of menstruation.However, there are other symptoms: headache, nausea, vomiting, sleep disorders, etc.Virtually all authors agree on the fact that dysmenorrhea should be divided into primary and secondary.
1. Primary dysmenorrhea usually occurs at a young age, often immediately upon establishing or 1-1.5 month thereafter.This state is characterized:
• Lower abdominal pain - pain is usually sharp, begins on the first day of the cycle.The pain is severe, sometimes unbearable, may be given in the back, in the legs.
• Cerebral disorders - sleep disorders, headaches, fainting.
• dyspeptic complaints - nausea, vomiting, diarrhea.
last two complaints favor prostaglandin theory of pain, as the increase in GHG can promote described complaints and is monthly.
not detected When viewed organs pathology.Often patients begin "premenstrual syndrome" - waiting for the onset of painful menstruation.It can complicate diagnosis and treatment.
2. Secondary dysmenorrhea: Evidence of pain associated with any disease.List of gynecological diseases, which may cause algodismenorei enormous.Here are just the main reasons:
• Endometriosis - a common cause of painful menstruation;but pain during menstruation attention is drawn to the irregularity of the menstrual cycle, spotting a dark brown discharge from the external genital tract before menstruation and immediately after them;during the inspection can be found in the formation of the pelvis, possibly on the neck.
• Ovarian tumors.
• Varicose veins of the pelvis and pelvic veins - a common cause of undiagnosed pelvic pain.
• Uterine fibroids - perhaps with submucosal fibroids.
• Inflammatory processes in the pelvis.
• Infectious lesions (gonorrhea, etc.).
• Navy Application (intrauterine device) do not contain progesterone - increased levels of prostaglandins, which leads to pain.
• adhesive process in the pelvis.
• Malformations - dysmenorrhea occurs most often when the evils that impede the outflow of blood from the uterus (uterine horn additional closed).Most often detected at an early age in patients with primary form.Treatment operative.
main symptoms of secondary dysmenorrhea are:
• Severe pain in the abdomen, exhausting sick.
• Insomnia, headaches, fatigue, until the disability.
• taste perversion, dyspeptic complaints.
• Frequent urination.
These symptoms occur during the first days of menstruation, can continue all the days, and even move to the beginning of a new cycle.
It is also necessary to share the pain in their degree of severity:
1. Easy (I degree of dysmenorrhea) - pains are mild, however, occur in each cycle, a woman does not take painkillers.
2. Moderate (II degree) - pain whenever menstruation;stronger, but acting in film taking of drugs;may cause other symptoms of dysmenorrhea, or symptoms of the underlying disease.
3. Heavy (III degree) - severe pain, medication does not help the patient, pronounced other symptoms.
1. Psychosomatic - possible development of psychosis in the background for a long time not how it relieves pain associated with menses.
2. With late diagnosis of the causes of pain in the form of a high risk of secondary transfer of the underlying disease in incurable form (eg oncology).
3. Persistent disability.
1. Examination of the patient.Attention is paid to the patient's age, the age at which first appeared similar complaints, the presence of associated symptoms;at survey drew the kind of patient - exhausted, "worn out."Palpable with primary dysmenorrhea form, usually nothing is defined in the secondary can be determined by: increase in size of the uterus, the presence of entities in the pelvis, in the presence of infiltrates parameters etc.
2. Laboratory examination methods.As a rule, change is possible to meet with the secondary form of dysmenorrhea, consistent with the nature of changes in the assays at varying primary pathology.
3. ultrasound.Ultrasound in primary form little information;the secondary form can help in the diagnosis of the causes of pain, upon detection of cysts, fibroids, tumors, etc.
4. MRI, CT is used rarely, if uninformative ultrasound and suspected presence of structures in the pelvis.
5. Encephalography.A woman may (rarely) to complain in the first place of the unbearable headache.In such a case requires diagnostics for CNS pathology.
6. Hysteroscopy for diagnosing adhesions inside the uterus (Ashshermana disease), for the diagnosis of adenomyosis.It is used rarely.
7. Diagnostic laparoscopy.If it is impossible to determine the cause of pain have resorted to this method, which allows a detailed assessment of the state of the abdomen and pelvis.Apply in extreme cases.
8. may need expert advice: the surgeon, urologist, neurologist, psychiatrist
Treatment Treatment is aimed at eliminating the pain symptoms, as well as possible, determine the cause, caused it.In secondary dysmenorrhea main form is the elimination of the underlying pathology.Only cure for the underlying disease will help to relieve pain.
When the primary form of treatment for dysmenorrhea is advisable to start with the appointment of non-steroidal anti-inflammatory drugs that can inhibit prostaglandins: ibuprofen, aspirin, nimesulide, diclofenac.Prescribe them for 48-72 hours, 1-3 times a day depending on the intensity of pain.Perhaps prophylactic administration for 1-3 days before menstruation (for 2-4 months).
also possible to assign the highly selective progestin - gestodene, combined estrogen-progestogen contraceptives.
actively used in the treatment of pain physiotherapy methods: electrophoresis, acupuncture, the application of heat to the lower abdomen.
It is also possible the use of sedatives: valerian tincture, trioksazina the night before, during or after menstruation.Many women enjoy the advice of a psychologist.
It is important to note the following - when a sharply painful menses for several cycles should consult a qualified obstetrician-gynecologist, because it may be the first symptom of a terrible disease.
Self is possible with mild to moderate disease, but you should consult your gynecologist about this during the inspection.In severe you must consult your doctor immediately.
Doctor gynecologist-endocrinologist Kupatadze DD